Hospital Support for Breastfeeding: On the Cusp of Big Changes, Time to Step It Up

Tuesday, November 11, 2014

Baby Hand on GlassHere is some good news out of Detroit: This summer, St. John Hospital & Medical Center became the first hospital in the city to be designated as “Baby-Friendly.”

The Baby-Friendly Hospital designation was created in 1991 by the World Health Organization and the United Nations Children’s Fund to increase breastfeeding rates worldwide and thereby improve maternal and child health, including infant survival. Hospitals and birth centers in the U.S. can be designated Baby-Friendly by following the “10 Steps to Successful Breastfeeding,” which include training staff in breastfeeding care, helping mothers initiate breastfeeding within 1 hour of birth, and ensuring that mothers and infants can “room in” and stay together 24 hours a day.

Given our understanding that optimal breastfeeding reduces infant mortality, access to hospitals that promote and support breastfeeding is especially important for Detroit, where the infant mortality rate—15 deaths in the first year for every 1,000 live births—remains more than two and a half times the national average and is even higher among Detroit’s African-American community.

Dr. Paula K. Schreck, who headed the Baby-Friendly effort at St. John; and Dr. Barbara L. Philipp of Boston Medical Center, who for decades has been at the forefront of hospital change in support of breastfeeding, saluted St. John and the growing Baby-Friendly Hospital movement in an op-ed in The Detroit News, pointing to the critical role that hospitals can play in closing the persistent racial gap in breastfeeding rates nationwide. “Breastfeeding is an equalizer,” write Drs. Schreck and Philipp. “It’s something that nearly every mom can do, regardless of where she lives or her socioeconomic status. Therefore, more Baby-Friendly Hospitals should equal more healthy moms and babies.”

The urgency of Drs. Schreck and Philipp’s message is underscored by a study from the Centers for Disease Control and Prevention issued in August that suggests that hospitals may play a role in the racial disparities in breastfeeding rates. As reported by Women’s eNews, the study found that hospitals and birth centers in ZIP codes with more than 12.2% Black residents (the national average) were less likely to implement key practices related to supporting breastfeeding.

One sure way to close the racial gap is to help more hospitals serving communities of color to become Baby-Friendly. Research shows that new mothers who experience 6 of the 10 steps are 13 times more likely to continue breastfeeding at 6 weeks postpartum than mothers who are not exposed to any of the 10 steps. Another study found that adherence to the 10 steps decreases racial, ethnic, and sociocultural disparities in breastfeeding rates in U.S. hospitals.

To help maternity facilities become centers of breastfeeding support, Dr. Philipp and a team of experts has designed an annual series of conferences for hospital leadership called the MotherBaby Summit, which brings together hospital administrators, maternity directors, doctors, nurses and lactation consultants. There are now MotherBaby Summits in Louisiana, Michigan, the Philadelphia metropolitan area, Dr. Philipp’s home state of Massachusetts, and several other places.

In Massachusetts, summit participation has more than doubled in 6 years, growing from 80 to 195 participants. All of Massachusetts’ maternity care facilities have “banned the bags,” meaning that they have stopped distributing infant formula gift bags to patients because of their negative effect on breastfeeding rates. Six of Massachusetts’ 48 maternity care facilities have become Baby-Friendly certified, and 15 more are on the pathway to certification.

Other states with MotherBaby Summits are experiencing similar momentum. Over the course of three summits, the number of maternity hospitals in Philadelphia and surrounding counties that have banned the bags has grown from 4 to 17 (out of 23 total), two Pennsylvania hospitals are Baby-Friendly certified, and all six of Philadelphia’s maternity hospitals are working toward certification. Michigan has seen similar progress over 3 years of summits, with nearly three-fourths of maternity hospitals in the state banning the bags, including all of the maternity hospitals in Detroit and Grand Rapids. Four maternity hospitals are now Baby-Friendly certified, including the largest hospital in the United States (with 8,000 births annually) to get this designation, and 11 more are on the way.

In Mississippi, the Baby-Friendly movement is taking root. The lieutenant governor recently signed a breastfeeding proclamation that encourages hospitals and health care professionals to follow the principles of the Baby-Friendly Hospital Initiative. California may prove the tipping point, with legislation passed in 2013 requiring all California maternity hospitals to be Baby-Friendly by 2025.

Nationwide, the number of Baby-Friendly Hospitals continues apace. In 2007, only 2.9% of U.S. births took place in Baby-Friendly Hospitals. Today, there are 203 Baby-Friendly Hospitals in the United States, accounting for 8.1% of births.

With a solid foundation and growing momentum, the movement to make all our maternity care facilities breastfeeding supportive, through Baby-Friendly designation and allied efforts, is poised for enduring success.

Whether you’re a hospital administrator, a health care professional associated with a hospital or a community member, a parent, or a parent-to-be, you can push for change at your hospital or support changes underway. Even hospitals that are already Baby-Friendly can continue to improve. There’s never been a better time for all of us to step up our efforts.

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